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Medicare is a federal health insurance program for people 65 years old or older, certain disabled people younger than 65, and people with End-Stage Renal Disease.
Medicare has four parts:
Medicare Part A is hospital insurance that helps pay for inpatient hospital stays, rehabilitative nursing facilities, home health care, and hospice. You likely will not have to pay a premium for Part A, because you prepaid the premium through payroll taxes while you were working. You are generally automatically enrolled in Medicare hospital insurance (Part A) without a premium, when you apply for Social Security benefits – usually upon reaching 65 years of age, or after receiving disability payments for two years and if you have 10 years of creditable employment.
Medicare Part B is medical insurance that helps pay for doctors' services and outpatient care. You will pay a monthly premium for Part B. If you do not sign up for Part B when you become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you were eligible but do not enroll. You are responsible for paying the Part B premium that is usually deducted from your Social Security benefits. Medicare pays for many healthcare services and supplies, but not all of your healthcare costs. For example, you pay a deductible for each hospital stay and may pay coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.
Medicare Part C is the Medicare Advantage program. With this option, you can choose to have your Medicare Parts A and B provided by a private insurance company like CarePlus. A Medicare Advantage plan provides Part A and Part B coverage – and generally, additional benefits, which may include Part D coverage.
Medicare Part D is prescription drug coverage. If you do not enroll in Part D when you become eligible you may have to pay a penalty when you enroll.
Medicare Advantage is a type of health plan that lets you get your Original Medicare benefits from a private insurance company. The Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 created Medicare Advantage. Some examples of Medicare Advantage plans are:
An HMO features specific lists of in-network doctors, hospitals, and other providers that you must use to receive benefits. You generally must get your care and services from providers in the plan's network, except for emergency care, out-of-area urgent care, and out-of-area dialysis. In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.
Anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, is eligible to enroll in Medicare Part D, which is a prescription drug benefit plan. This benefit was designed to help Medicare consumers access and pay for prescription drugs. Most CarePlus Medicare Advantage plans include Part D prescription drug coverage in addition to hospital and medical coverage.
A PDP is a private, stand-alone plan (PDP) that only offers coverage for prescription medications, (Part D coverage). You can use this plan with Original Medicare or with a Medigap plan. CarePlus does not offer a stand-alone prescription drug plan. Prescription drug coverage is included in most of our Medicare Advantage plans. All Medicare Advantage plans also include Part A hospital coverage and Part B medical coverage.
You cannot enroll in more than one PDP at the same time, or in a PDP and a Medicare Advantage plan that includes prescription drug coverage (MAPD). Exceptions include Medicare Advantage PFFS plans that do not offer the Part D benefit, a Medicare Savings Account (MSA), or exceptions provided under CMS waiver authority.
If you are considering a PDP, please keep the following in mind:
Preferred cost-share pharmacies provide prescriptions at a lower cost-share (e.g., copayments) than standard cost-share pharmacies.
Standard cost-share pharmacies provide prescriptions at a higher cost-share (e.g., copayments) than preferred cost-share pharmacies.
Before you select a plan, carefully consider the following questions:
If you recently became eligible for Medicare, through age or disability, you generally have the option to apply for coverage in a Medicare Advantage plan close to the date when your Medicare Part A and Part B coverage starts.
Your Medicare Advantage plan cannot start before both your Part A and Part B coverage begins. However, you generally have a period of seven months to apply for Medicare Advantage plan coverage.
This means you can apply for a Medicare Advantage plan three months before, the month of, or three months after your Medicare Part A and Part B coverage starts. You must be enrolled in Medicare Part A and in Medicare Part B. This period is known as the Initial Coverage Election Period (ICEP).
Already enrolled in Medicare?
If you did not recently become eligible for Medicare, your enrollment options are different and may be limited to certain times during the year.
During this time, you may change or enroll in a Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), or prescription drug plan (PDP), or return to Original Medicare. Changes made during this period will take effect on January 1 of the following year.
If you enrolled in a Medicare Advantage plan, you can switch plans or return to Original Medicare during this time. You can change plans only one time during this enrollment period.
In certain situations, outside of the ICEP or AEP, Medicare beneficiaries may be able to join, switch, or leave a Medicare Advantage plan or a prescription drug plan during a Special Enrollment Period (SEP).
Some examples of special enrollment situations are:
For more information about Medicare Advantage or Prescription Drug plans you can call the Centers for Medicare & Medicaid Services (CMS), or go online:
Centers for Medicare & Medicaid Services (CMS)
24 hours a day, 7 days a week
For more information about Medical Assistance through the state, you can contact Florida Medicaid or call your State Health Insurance Assistance Program (SHINE).
Florida Medicaid (Agency for Health Care Administration)
Address: 2727 Mahan Drive, Mail Stop 33
Tallahassee, FL 32308
Monday - Friday, 8 a.m. to 5 p.m.
SHINE (Florida SHIP-SMP)
Department of Elder Affairs
Address: 4040 Esplanade Way, Suite 270
Tallahassee, FL 32399-7000
Monday - Friday, 8 a.m. to 5 p.m.
For more information about Social Security or Railroad Retirement earnings, call or go online:
Social Security Administration (SSA)
Monday - Friday, 8 a.m. to 7 p.m.
(Generally, you’ll have a shorter wait time if you call Wednesday through Friday, before 10 a.m. or after 3 p.m during the second half of the month)
U.S. Railroad Retirement Board
9 a.m. to 3:30 p.m. on Monday, Tuesday, Thursdays, and Friday
9 a.m. to noon on Wednesday
Address: 844 North Rush Street
Chicago IL, 60611-1275